1. Physician Assistants Optimizing Patient Care

2. Presentation Objectives What is a PA? Scope of Practice PAs in Canada The Impact on the Health Care System The Value of PAs Obstacles to Advancement of the Profession

3. A Physician Assistant is a health care provider who extends the hand of the supervising physician The profession was developed within the Canadian Forces to provide full spectrum medical care as part of a physician led team PAs are trained under the medical model What is a PA?

4. A dependent practitioner who works under the delegation of a supervising licensed physician Can be entrusted to make certain decisions and to carry out certain actions autonomously The PA is not intended to supplant or substitute the physician as the principal medical decision- maker PAs working with the supervising physician can enhance access to quality care for patients What is a PA?

5. PAs in Canada have been formally trained and educated to meet the national standard set by CAPA The National Competency Profile and Scope of Practice was developed in conjunction with the CFPC, CMA, and RCPSC PACCC administers and maintains the PA certification process Scope of Practice

6. Duties Generally Performed by PAs Medical histories and performing comprehensive physical examinations Complete admission and discharge procedures for hospital stays In some cases, refer patients for consultation with specialists Preventative health counseling Order and interpret laboratory tests, X-ray, and other diagnostic investigations What Can a PA Do?

7. Assist the physician in developing and implementing a patient management plan Record progress notes in isolated and in- patient care settings Perform and interpret common laboratory, radiological, ECG, and other routine diagnostic procedures used to identify patho- physiological processes Prescribe medication in accordance with medical directives and local legislation Surgical Assist Duties Generally Performed by PAs

8. PAs in Canada There are upwards of 300 Physician Assistants practicing in Canada in both civilian settings and within the Canadian Forces 4 provinces recognize PAs as a profession 4 nationally recognized reputable academic institutions offer PA programs In the US there are almost 85, 000 PAs practicing in health care settings and 156 accredited programs

9. PA Accredited Programs Canadian Forces Health Services Training Centre University of Manitoba Physician Assistant Education Program McMaster University Medical Sciences PA Program Consortium for PA Education (combination of the University of Toronto/Northern Ontario School of Medicine/Michener Institute for Applied Health Sciences)

10. Benefits to the Health Care System Today 4.5 million people in Canada do not have a regular medical doctor (“Canadian Community Health Survey”, Statistics Canada) PAs have been shown to enhance the delivery of care, improve access for patients and reduce wait times PAs can manage up to 62 % of all patients in emergency care and 75 % of all visits in primary care without referral to physician level care (“Staffing primary care in 1990: physician replacement and cost saving”, Schweitzer & Record)

11. Benefits to the Health Care System In orthopaedics PAs can increase the volume of primary joint procedures by 42 % a year and decrease wait times for surgeries by 14 weeks (“Experience with physician assistants in a Canadian arthroplasty program”, Bohm et al.) PAs in Emergency Departments can reduce wait times for patients by 1.9 times and cut the “left without being seen” rates by half ( “Impact on patient flow after the integration of nurse practitioners and physician assistants in Ontario emergency departments”, Ducharme et al. )

12. The Value of PAs Integrating PAs into health care will increase the level of service for patients and address the challenges that exist within today’s health system Collaborative approach that reduces the workload placed on the team and the physician The PA profession is designed to work in a team- based setting which fosters inter-professional collaboration among other health care providers

13. Obstacles to Advancement Lack of familiarity with the PA role and Scope of Practice Absence of a funding model(s) Recruitment and integration of PAs Liability insurance and coverage for the PA (“Barriers and Benefits to Hiring a Physician Assistant", Taylor et al.)

14. Funding There is no universal model for funding for PAs Funding for PAs varies dependent on the setting and location Typically PAs are funded through the government or directly through the physician

15. Future of the Profession The benefits to the health system are proven It is essential to create a funding structure for physicians to employee PAs Must remove the other barriers to employment Need to educate stakeholders on the benefits of the profession

16. Conclusion Physicians are optimistic about the PA profession The value that PAs bring to the health system is evident Without the support of local and provincial governments and other key health organizations the profession could become stagnant We need your support

17. Questions?